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Has Someone Been Talking to My Doctor?

So you thought you had a good relationship with the treating physician in your workers’ compensation case – even though workers’ comp got to pick the doctor. At all previous visits, the doctor listened attentively, sympathized with your condition and genuinely seemed to care about your recovery. Then everything changed at the next visit. You were hardly allowed to speak before being told there was nothing more that could be done to help you recover more fully. Today you would be released back to work with no restrictions and no follow up appointments are to be scheduled. What just happened?

Or maybe you were released from the hospital after a major back surgery with a prescription from your surgeon for temporary home health services because you live alone and need some help with personal needs. But the care never shows up. When you call the doctor’s office to find out what is going on, his assistant tells you he changed his mind. How can this be?

Communication with Your Physician

Unfortunately, you have probably had someone from your employer and/or the insurance company communicate with your doctor outside of your presence, ultimately resulting in cost savings to them. The worst part of it is that you probably consented to this communication at the very beginning of the claim when you signed the release they sent you that allows this type of behavior. Other times injured workers will allow “consulting physicians” from the insurance company to speak with their doctor about the care being provided, or before certain types of care are authorized, the insurance company will insist their “peer review professionals’ speak to the treating physician. These communications are often nothing more than thinly disguised brow-beatings and bullying of the treating physicians to find less expensive medical care, regardless of treatment efficacy. Sometimes, it is the nurse assigned to your case that seems to be more interested in saving the insurance company money than getting you better.

Are Defendants Allowed to Speak to Your Physician Without You?

Know the rules. The general rule is that defendants are not allowed to speak with your treating physician outside of your presence absent certain circumstances. N.C. Gen. Stat. §97-25.6 provides exceptions to this rule and governs when the defendants are allowed to communicate with providers and under what protective circumstances. Likewise, the NC Industrial Commission Rehab Rules set forth the few exceptions when nurse case managers can speak with your physician outside of your presence. Make sure you are aware of these exceptions!

Also, it’s fine to be cooperative with the insurance company by signing their release while they investigate your claim, just mark out any language allowing them to speak directly with your doctor outside of your presence. These rules are in place to encourage transparency and there is nothing wrong with insisting on this while your claim is being investigated or when the defendants require additional information from your doctor.

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